Baby After Fibroid Procedure Possible

Alternative to Hysterectomy Preserves Fertility, Less Complications Than Surgery

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March 31, 2003 (Salt Lake City, Utah) -- Uterine fibroids can not only cause pain but can actually hold women captive in their homes for several days every month because unremitting bleeding makes them worry about embarrassing accidents. Fibroids are also the leading reason women have a hysterectomy. But now, new research indicates that a non-surgical treatment for fibroids not only offers women freedom from the harrowing symptoms, but can also preserve their chances for a healthy pregnancy.

The procedure, called uterine artery embolization or uterine fibroid embolization, uses tiny particles to obstruct the blood flow to the fibroids. The particles, which look like tiny Styrofoam beads, are inserted by a tiny catheter into the uterine artery. Since fibroid blood flow is very rapid, the particles are carried by the flow to the source of the fibroid blood supply, where the particles clump together to block the blood flow.

Once the blood supply is shut down the fibroid, which can sometimes grow to the size of a second trimester pregnancy, shrinks and eventually sloughs off. But while doctors knew the procedure worked, they are only now confirming that women can become pregnant and deliver healthy babies after the procedure.

Follow up results from a Canadian study of 550 women who had uterine artery embolization or UFE as it is called found that 17 of the women reported 19 pregnancies. At the time of the study about 30% of the women said they did want to become pregnant, says researcher Gaylene Pron, PhD, an epidemiologist with the department of public health sciences at the University of Toronto.

Those women were told that no one knew if UFE would hurt their chances for pregnancy and they were told about a surgical option for some women called myomectomy in which the fibroid is cut away from the uterus. Obstetricians report that women can become pregnant after a myomectomy, but Pron says that the pregnancy rates are no higher than what was seen among women in her study.

She presented her research at the 28th Annual Scientific Meeting of the Society of Interventional Radiology held here.

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While Pron is encouraged by her study results, she says there is still no definitive answer for women faced with a choice between surgery and UFE. "That is the study that needs to be done: a randomized trial comparing fertility after UFE to fertility after myomectomy," she says.

Pron said women in the study were "advised to wait for three or four months after the procedure before attempting to conceive, and this is roughly the same advice given after myomectomy." There were three miscarriages and one therapeutic abortion among the 19 pregnancies. "There have been 14 live births so far and one more is expected next month," she says.

Interestingly, 13 of the 15 women had "a history of prior miscarriage -- one woman had nine prior miscarriages. Twelve of the women had no babies before the procedure," Pron says. That suggests that untreated fibroid disease may "impair fertility." Eighteen of the 19 pregnancies were "achieved without fertility treatments, one was achieved using in vitro fertilization," she says.

Even women who aren't planning families may be interested in UFE because the procedure has fewer complications then surgery and usually gets them out of the hospital and back to work much faster says James Spies, MD, professor of radiology at Georgetown University. He also presented current research at the radiology meeting,

Spies compared UFE to hysterectomy in women who had symptomatic fibroid disease. He says that 102 underwent UFE and 50 women had hysterectomies. Less than 28% of women who had UFE reported complications from the procedure while half of the women who had hysterectomies reported complications. But Spies says that in both groups "the complications were very minor."

He says that women who had UFE were out of the hospital in less than a day, compared to at least two days of hospitalization for women who had surgery. "And the women treated with UFE returned to work in just over 10 days compared to more than a month out of work for women who had hysterectomies," Spies says.

While he didn't look at fertility, Spies says he is not surprised that women can become pregnant after UFE.

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John C. Lipman, MD, of the Center for Minimally Invasive Therapy in Atlanta, Ga., was not involved in either study but he agrees that UFE has several advantages over surgery. Lipman, who has a large UFE practice, also thinks that UFE has a positive effect on fertility, but he admits that is an "impression." He says that only further study can definitively answer the question. Until then "we have to rely upon results such as those from the Canadian study."

SOURCE: 28TH Annual Scientific Meeting of the Society of Interventional Radiology. Abstract 12 and Abstract 501.

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